Advances in Kawasaki disease: Interventional Catheterization for Coronary Artery Obstruction

During past 10 years, the clinical experience of catheter interventional treatment in Kawasaki disease has been gradually increasing. These include balloon angioplasty, stent implantation, rotational ablation and transluminal coronary revascularization. Because the coronary artery stenosis in Kawasaki disease commonly involves severe calcification in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly employed in Kawasaki disease patients. Satisfactory acute results for coronary balloon angioplasty can be obtained for patients with a relatively short interval from the onset of disease, especially within 6 years; however, the incidence of restenosis after angioplasty is still high. Rotational ablation may be the most appropriate catheter intervention for Kawasaki disease. The advantage of rotational ablation is the high success rate, even in patients with calcified coronary artery stenosis. Stent implantation requires larger arterial access and is not possible in younger children. Care should be paid to the detection of new aneurysm formation, as the formation of new aneurysms is associated with the use of additional balloon angioplasty using high pressure balloon inflations. Anticoagulation or anti-platelet regimens are essential for the long-term management.